How the doughnut hole affects prescription fulfillment decisions involving cardiovascular medications for Medicare Part D enrollees.

PURPOSE

The unsupplemented Medicare Part D prescription drug benefit does not provide coverage for stand-alone prescription drug plan (PDP) beneficiaries within the coverage gap (often called a doughnut hole) in Medicare Part D.

DESIGN

We evaluated whether the doughnut hole was a factor in altering prescription fulfillment decisions regarding cardiovascular medications in Part D beneficiaries.

METHODOLOGY

We investigated 500 Medicare Part D members' pharmacy adjudication records (all prescription transactions) for one full year from a blinded, national Part D HMO pharmacy database. We selected 250 stand-alone PDP beneficiaries without coverage in the doughnut hole and 250 Medicare Advantage-Prescription Drug (MA-PD) plan beneficiaries whose prescription coverage did not lapse in the doughnut hole by way of random stratified sampling and analyzed the records using multinomial logistic regression for their prescription fulfillment decision endpoints of filling, delaying, switching, or stopping their medications.

FINDINGS

Of stand-alone PDP beneficiaries, 16.8% delayed medication, 12.4% switched medication, 10.4% both delayed and stopped medication, and 9.6% stopped at least one medication. Part D enrollees who entered the doughnut hole are 1.5 times as likely to delay their cardiovascular prescriptions (OR = 1.54, 95% CI 0.924, 2.562), 1.5 times as likely to switch and delay their cardiovascular prescriptions (OR = 1.52, 95% CI 0.532, 4.332), and 2.3 times as likely to delay and stop their cardiovascular prescriptions than beneficiaries with coverage through the doughnut hole period (OR = 2.30, 95% CI 1.134, 4.673).

CONCLUSIONS

For cardiovascular medications, the presence of a doughnut hole affects the prescription fulfillment decisions made by Part D beneficiaries.